128例溃疡性结肠炎内镜资料分析

目的：总结我国溃疡性结肠炎（ＵＣ）大肠镜下表现和特点。方法：对我院１９７６～１９９９年间大肠镜资料进行了回顾性分析。结果：拟诊ＵＣ者共１４２例,确诊１２８全然在肠镜诊断正确率为９０．１％。病变部位以直乙结肠、左侧结肠、全结肠型多见,９５．４％病变累及直肠;内镜下１／２～２／３患者表现为粘膜破坏、炎症和出血,１／３表现为粘膜增生;罕见癌变。结论：鉴于我国ＵＣ低癌变,绝大部分有直乙结肠病变,故认为经济     

128例溃疡性结肠炎临床资料分析

目的：总结溃疡性结肠炎（ＵＣ）临床表现和特点。方法对临床及结肠镜拟诊ＵＣ者的资料进行回顾性分析，结果拟诊ＵＣ者共１４２例，确诊１２８例。２６．６％发病前有菌痢史，男女之比为２：１；好发年龄为２０－５９岁；粘液脓血便、腹泻、腹痛为主要症状，发热、贫血等为次要表现，多数有３种以上临床表现；病变部位以直肠，乙肠、降结肠、全结肠型多见，９５．４％病变累及直肠；未见癌变。结论结果提示菌痢可能在ＵＣ发病中起一     

内镜下圈套切除巨大结肠直肠息肉的探讨

目的：探讨内镜下治疗巨大结肠直肠息肉的可行性和安全性。方法：无蒂息肉采取逐渐切除的方法,有蒂息肉则横断切除蒂的方法。结果：内镜下圈套切除１７０例患者,共切除大的（≥３ｃｍ）息肉１７６颗。出血是息肉切除术仅有的并发症占２４．１％,除１例需住院止血,其它所有出血都经过内镜下治疗止血。切除的息肉组织学均为腺瘤,同时伴有恶恋的占１２．３％。１３２例患者随访在６个月以上。结论：内镜下切除巨大结肠直肠息肉是可     

系统性红斑狼疮女性患血清3种肿瘤标记物的测定

了解系统性红斑狼疮患者血清肿瘤标记物ＣＡ１２５、ＣＡ１５．３、ＣＡ１９．９的阳性率及其临床意义。方法采用微粒子酶免疫法检测了１８６例ＳＬＥ女性患者的血清标本。结果：ＳＬＥ患者血清ＣＡ１２５、ＣＡ１５．３、ＣＡ１９．９、的阳性率分别为２４．７％、１６７．７％、１５．１％。ＣＡ１２５大于１００ＫＵ／Ｌ的ＳＬＥ患者关节与浆膜炎较多见。结论：ＣＡＤ１２５、ＣＡ１５．３ＣＡ１９．９不仅是妇科肿瘤的标记物,在     

84例自身免疫性溶血性贫血IgG抗体亚型与临床意义的分析

目的　研究温抗体型自身免疫性溶血性贫血ＩｇＧ亚型及其临床意义。方法　回顾性分析８４ 例患者ＩｇＧ亚型与临床特点的关系。结果　８４ 例患者中ＩｇＧ１ ＋ＩｇＧ３ ＋ Ｃ３ｄ 型占４５．０％ ,ＩｇＧ１ ＋ＩｇＧ３型占１５ ．５％ ,ＩｇＧ１ ＋ Ｃ３ｄ型占１１．０％ ,Ｃ３ｄ型占１０ ．７％ ,ＩｇＧ１ 型占９．５％ ,ＩｇＧ３ ＋ Ｃ３ｄ占８．３ ％ 。各型中均以女性为主,合计占６９ ．５％ 。ＩｇＧ３ 阳性各型的临床表现相似,各项临床指标异常最严重;ＩｇＧ１ 阳性的各型次之;Ｃ３ｄ 型最轻。Ｈｂ＜６０ ｇ／Ｌ、总胆红素＞ ４０ μｍｏｌ／Ｌ、ＦＨｂ＞ ６０ ｍｇ／Ｌ的患者百分率三组间比较,差异有显著性（Ｐ＜０ ．０５） 。ＩｇＧ１ 型与ＩｇＧ３ 型都随Ｃｏｏｍｂｓ 试验积分增高,其临床表现及溶血程度加重。ＩｇＧ３ 阳性的患者治疗有效率为６８ ．２％ ,ＩｇＧ１ 阳性患者有效率为１００％ 。结论　ＩｇＧ 亚型中以ＩｇＧ１ ＋ＩｇＧ３ 为主。ＩｇＧ３ 阳性的患者临床表现及溶血程度严重,治疗效果差     

超声心动图对新生儿细小动脉导管未闭预后的观察

目的：观察新生儿动脉导管未闭的自然闭合时间及不同情况下应采取的相应措施。方法：应用ＡＣＵＳＯＮ１２８ＸＰ／１０彩超仪观察动脉导且细、长度、分流方向、时相及速度、分流压差。选择导管内径２～４．３ｍｍ新生儿共２９例,３,６,１２个月进行超声心动图追踪观察。结果：自然闭合者３个月内２５例,占８６．２％;６个月２例,占６．９％;１２个月１例,占３．４％;１例早产、低体重儿,动脉导管未闭合并房间隔小缺损,同     

应用内镜对胃癌前期病变1132例的随访观察

报道我院应用内镜活检对胃癌前期病变１１３２例进行了３个月～１５年随访观察，结果也表明：这些病变有一定的可逆转性；本组总癌变３５例（占３．１％），其中癌变率ＧＵ＋ＡＴＰ或伴ＣＡＧ组４．１％，ＣＡＧ＋ＩＭ或伴ＡＴＰ组４．０％，ＡＴＰ组３．７％，ＧＳ组３．３％，ＩＭ组２．４％，ＣＡＧ组２．２％，早癌１７例，占胃癌总数的４８．６％，较门诊早癌检出率（７．２％）高６．８倍，内镜活检随访是当前发现早癌的可靠途     

能量多普勒和TCCS联合应用在诊断脑肿瘤中的价值

目的：通过超声诊断２９例脑肿瘤，评价在ＴＣＣＳ检查的基础上运用能量多普勒对脑肿瘤诊断的临床应用价值。方法：经颞窗和枕窗对２９例脑肿瘤患者进行ＴＣＣＳ检查，采用能量多普勒显示肿瘤病灶外周及内部血流分布状况，将血流信号分级进行半定量评价。结果：ＴＣＣＳ共检出脑肿瘤２８例，漏诊１例。１２例Ⅲ－Ⅳ级胶质瘤均呈强回声，６例（５０％）内部可见明显低回声区；其余１６例Ⅰ－Ⅱ级胶质瘤、脑膜瘤和垂体瘤中１３例呈强回声，回声均匀。肿瘤内血流信号能量多普勒显示分级：１２例恶性胶质瘤中１０例（８３．３％）３级，２例２级；１６例分化较好的脑肿瘤中３例２级，１３例０－１级。１２例恶性胶质瘤Ｖｍａｘ＝２１．７０±９．２９ｃｍ／ｓ，ＰＩ＝０．６８±０．２５。结论：在ＴＣＣＳ检查基础上采用能量多普勒能较好显示脑肿瘤内血运情况，提高良、恶性脑肿瘤的鉴别诊断率。     

抗钙调素自身抗体测定方法的建立及应用

自人脑提取钙调素（ＣａＭ），制备兔抗人ＣａＭ抗体，建立了检测抗ＣａＭ自身抗体的间接酶联免疫吸附试验方法，批内、批间误差变异系数均＜９．０％，抗ＣａＭ阳性血清用ＣａＭ吸收后吸光度值下降９０％。抗ＣａＭ抗体活性用Ｕ／ｍｌ表示，正常对照（ｎ＝１００）为７．５６±２．６８Ｕ／ｍｌ，以ｘ＋２ｓ为正常上限，＞１２．９２Ｕ／ｍｌ为阳性。各种自身免疫病患者抗ＣａＭ的水平与阳性率依次为系统性红斑狼疮（ｎ＝３２）：２６１５±１１．７Ｕ／ｍｌ，５１．１％；类风湿性关节炎（ｎ＝２８）：１３．６１±９．７Ｕ／ｍｌ，２１．４％；桥本甲状腺炎（ｎ＝２５）：５９．０７±９８．４Ｕ／ｍｌ，６０．０％；甲状腺机能亢进（ｎ＝３４）：３７．７６±８４．７Ｕ／ｍｌ，４７．１％；肝炎（ｎ＝４３）：２３．１７±６．７Ｕ／ｍｌ，４４．２％。均显著高于正常对照（Ｐ＜０．０１或Ｐ＜０．０５）。抗ＣａＭ抗体与抗核抗体常同时存在，但与抗甲状腺球蛋白、抗甲状腺微粒体自身抗体无显著相关关系（Ｐ＞０．０５）。     

神经生长因子对大鼠脑缺血后海马CA1区神经细胞凋亡的影响

目的：研究神经生长因子（ＮＧＦ）对缺血性脑损伤中神经细胞凋亡的影响。方法：采用大鼠全脑缺血模型，ＴＵＮＥＬ方法原位标记ＤＮＡ片段，观察脑室内注射ＮＧＦ后海马ＣＡ１区神经细胞凋亡的变化。结果：使用ＮＧＦ后３日海马ＣＡ１区ＴＵＮＥＬ阳性神经细胞数为锥体细胞总数的１３．９％±１１．６％，与缺血对照组（２１．３％±１３．７％）比较显著减少（Ｐ＜０．０１）。结论：外源性ＮＧＦ对脑缺血所致的神经细胞凋亡可能具有一定的保护作用     

溃疡性结肠炎患者外周血CD4＋CD25＋调节性T细胞水平及其临床意义

目的：探讨溃疡性结肠炎（ UC）患者外周血CD4＋CD25＋调节性T细胞（ CD4＋CD25＋Treg）水平及其与疾病活动性关系。方法采用流式细胞仪检测50例不同病期UC患者（ UC组）和50名正常人（对照组）的外周血CD4＋CD25＋Treg水平,全自动ESR分析仪测定ESR。结果活动期UC组外周血CD4＋CD25＋Treg水平均明显低于对照组,且随着其病情程度的加重,其水平逐渐降低（P＜0.05）。 UC组CD4＋CD25＋Treg水平与ESR水平呈负相关（r＝-0.432, P＜0.05）。结论 UC患者外周血CD4＋CD25＋Treg降低水平与其炎症活动程度相关,其水平检测有助于判断病情严重程度。     

溃疡性结肠炎患者外周血单个核细胞中TREM-lmRNA 的表达水平

目的 通过比较髓系细胞触发受体-1(TREM-1)mRNA在活动期和缓解期溃疡性结肠炎(UC)患者以及健康体检者外周血单个核细胞(PBMC)中的表达水平,探讨TREM-1与UC疾病活动性的关系.方法 依据结肠镜检和病理活检结果,将UC患者分为活动期和缓解期2组,采用实时荧光定量逆转录(FQ-RT)-PCR检测70例UC患者(活动期患者38例,缓解期患者32例)和20名健康体检者PBMC中TREM-1 mRNA的表达水平,采用相对定量ACt值比较基因表达水平的高低,并比较TREM-1 mRNA表达水平与ESR和C反应蛋白(CRP)的相关性.结果 UC活动期患者PBMC中TREM-1 mRNA的表达水平(4.19±1.86)显著高于uC缓解期患者(5.29±1.71,P=0.007)和健康体检者(5.19±1.04,P=0.032),而UC缓解期患者与健康对照组差异无统计学意义(P=0.892);TREM-1 mRNA表达的受试者操作特性曲线(ROC)下面积为0.763(P<0.001),表明TREM-1 mRNA表达水平对UC疾病活动性具有诊断价值;当△Ct值为4.63时,是判断UC活动性的最佳临界点,其诊断的敏感度和特异度分别为73.7%和68.7%;UC活动期患者中TREM-1 mRNA的表达与ESR显著相关(r=0.582,P=0.03),而与血清中CRP水平不相关(r=0.447,P=0.055).结论 TREM-1mRNA的表达与UC的活动程度明显相关,TREM-1可能参与了UC的炎症进程.TREM-1 mRNA的表达水平可能与ESR相关,而与血清中CRP水平不相关.     

Oral beclomethasone dipropionate in patients with mild to moderate ulcerative colitis: A dose-finding study

Systemic glucocorticosteroids have demonstrated efficacy in ulcerative colitis (UC) but cause undesired systemic side effects. Beclomethasone dipropionate (BDP) has potent topical activity and is extensively metabolized. This randomized doubleblind study investigated an oral gastroresistant controlled-release preparation of BDP in 57 patients with mild to moderately severe extensive or left-sided UC. Patients were assigned to receive BDP 5 or 10 mg/d; a third group took a clinically inactive dose (1.6 g/d) of 5-aminosalicylic acid (5-ASA). Both BDP doses displayed excellent efficacy confirmed by results of endoscopy, biopsy, and clinical evaluation. Significant improvement from baseline occurred in most signs and symptoms of UC, particularly stool frequency, rectal bleeding, and mucus in the stool (P<.01). Tolerability was good in both BDP groups. Morning plasma cortisol levels decreased significantly from baseline with BDP 10 mg, but no significant changes in vital signs were observed at the end of treatment. Despite a small sample size and the open comparison with 5-ASA, this multicenter study showed the therapeutic equivalence of BDP 5 and 10 mg/d in alleviating clinical symptoms and improving endoscopic and biopsy scores in patients with mild to moderate UC. BDP 5 mg/d displayed better general tolerability and less reduction of plasma cortisol levels, however, and may be preferable to the higher dose in this indication.     

Is histological investigation of polyps always necessary?

BACKGROUND AND STUDY AIMS: To assess whether polyp histological type can be predicted by patient characteristics and endoscopic polyp findings. PATIENTS AND METHODS: 1681 polyps in 494 patients were categorized as advanced adenomas (villous component or severe dysplasia or early cancer) or insignificant polyps. Chi-squared tests were used to analyze whether polyp histological type could be predicted based on patient age (< 60 vs. > or = 60 years), gender, family history of colon polyps or cancer, presence of anemia, polyp size (< or = 5 mm vs. > 10 mm), and location (left- vs. right-sided). RESULTS: Insignificant polyp histology (n = 1337) correlated with patient age < 60 years (P = 0.0026), lack of anemia (P< 0.0001), polyp size < or = 5 mm (P < 0.0001), and right-sided location (P= 0.0058). Stepwise inclusion of these parameters demonstrated that the association of a < or = 5 mm right-sided polyp in a patient < 60 years yielded the highest combined predictive value (96.2%) for an insignificant polyp. Conversely, age > or = 60 years, presence of anemia, polyp size > 10 mm, or left-sided location, as single or combined parameters, demonstrated a maximum predictive value of only 75.4% for an advanced adenoma. CONCLUSIONS: A small right-sided polyp in a young patient is associated with a small risk (3.8 %) for advanced adenomatous tissue, indicating that histological investigation of such a polyp might not always be necessary. However, the recent recognition of flat adenomas and "mini" de novo colon carcinomas in the European population also may limit the usefulness of small polyp diameters in the exclusion of severe polyp histology.     

52例溃疡性结肠炎临床分析

目的探讨溃疡性结肠炎（UC）的临床特点。方法回顾性分析52例UC患者的临床资料。结果52例UC患者均经临床、钡剂灌肠和内镜及内镜下活检确诊，其中慢性复发型22例（42.3％）、初发型15例（22．8％）、急性暴发发型2例（3．8％）、慢性持续型13例（25．0％）。主要症状：腹痛41例（78．8％）、便血6例（11．5％）、腹泻9例（17.3％）、黏液脓血便43例（82．7％）、发热4例（7．7％）。按病情分为：轻型26例（50．0％）、中型16例（30．8％）、重型10例（19.2％）。病变范围：直肠型4例（7．7％）、直乙状结肠型14例（26．9％）、左半结肠型19例（36．5％）、右侧结肠型2例（3．8％）、全结肠型13例（25．0％）。肠外合并症5例（9．6％），并发症2例（3．8％）。不同病情患者的体温、血沉、白细胞、血红蛋白、α2免疫球蛋白等指标相比均有显著性差异（P〈0．05或P〈0．01）。内科治疗50例，大多数患者用柳氮磺胺吡啶（SASP）治疗有效。结论掌握UC的临床特点可正确地诊断与治疗该病。     

溃疡性结肠炎的临床和内镜特点

目的：分析溃疡性结肠炎的临床特点、肠镜表现、病理和实验室检查结果,提高临床对溃疡性结肠炎的诊治水平。方法：回顾分析2000年1月—2008年6月确诊的129例溃疡性结肠炎患者的临床资料。结果：发病平均年龄43.04岁,41~50年龄段发病比例最高,男性多见。临床症状：腹痛、腹泻,粘液脓血便,里急后重。结肠镜表现：黏膜慢性炎症。病理：炎性细胞浸润,隐窝改变。实验室检查：血小板计数、红细胞沉降率显著高于正常对照组。结论：溃疡性结肠炎病变主要位于直肠和乙状结肠。血小板计数和红细胞沉降率有助于溃疡性结肠炎的分期分型。     

血浆肿瘤坏死因子受体相关因子-2升高与炎症性肠病内镜下疾病活动性的相关性分析

【目的】分析血浆肿瘤坏死因子受体相关因子-2（TRAF-2）水平对于炎症性肠病的诊断价值以及与内镜下疾病活动性的相关性。【方法】应用酶联免疫吸附试验（ELISA）分析炎症性肠病患者和正常对照者血浆中TRAF2蛋白的表达,受试者工作特征曲线（receiver-operating characteristic,ROc）分析血浆TRAF-2水平对于克罗恩病和溃疡性结肠炎的诊断价值,应用Pearson相关分析研究血浆TRAF-2水平与内镜下疾病活动性的相关性。数据处理使用GraphPad Prism5。【结果】克罗恩病患者和溃疡性结肠炎患者血浆TRAF-2水平显著高于正常对照者（P〈0．01）,同时TRAF-2对区分克罗恩病患者和正常对照者（P=0．001）以及区分溃疡性结肠炎患者和正常对照者（P=0．000）具有显著的诊断价值。克罗恩病患者（r=-0．097,P=0．455）以及溃疡性结肠炎患者（r=0．016,P=0．902）血浆TRA卜2表达水平和内镜下疾病活动指数均无显著的相关性。【结论】炎症性肠病患者血浆TRAF-2水平增高,对区分炎症性肠病患者和正常对照者具有诊断价值,但血浆中TRAF-2的水平不能反应内镜下疾病活动程度。     

中性粒细胞与淋巴细胞比值对初发溃疡性结肠炎鉴别诊断及其严重程度判断的临床意义

目的 评估中性粒细胞与淋巴细胞比值(NLR)对溃疡性结肠炎诊断的临床意义。方法 选取2009年6月～2016年6月就诊于上海长海医院的192例患者,其中溃疡性结肠炎患者97例,肠易激综合征患者95例。通过研究血常规中中性粒细胞与淋巴细胞比值(NLR),分析两组疾病NLR差异,并评价NLR对溃疡性结肠炎诊断的敏感度及特异度; 通过改良的Mayo评分系统评估溃疡性结肠炎疾病严重程度,并分别分析NLR在溃疡性结肠炎不同严重程度及不同病变部位之间的差异。结果 与肠易激综合征组相比,溃疡性结肠炎患者NLR显著增高,差异具有统计学意义(t=2.327,P<0.021); 诊断溃疡性结肠炎敏感度和特异度分别为69.1%和75.8%; NLR在溃疡性结肠炎严重程度之间差异有统计学意义(F=8.221,P=0.001); NLR在不同病变部位之间差异无统计学意义(F=0.737,P=0.483)。结论 NLR在溃疡性结肠炎与肠易激综合征鉴别诊断中具有一定价值和临床意义,并且可以判断溃疡性结肠炎的严重程度。     

Potential role of soluble angiopoietin-2 and Tie-2 in patients with inflammatory bowel disease

BACKGROUND: Angiogenesis has been suggested to play an important role in inflammatory bowel disease (IBD). The aim of the study was to evaluate the serum markers of angiogenesis angiopoietin-2 (Ang-2) and soluble angiopoietin receptor Tie-2 in patients with ulcerative colitis (UC) and Crohn's disease (CD). MATERIALS AND METHODS: Serum Ang-2 and Tie-2 serum levels were measured in 160 IBD patients (79 UC and 81 CD) and in 80 matched healthy controls using commercially available enzyme-linked immunosorbent assays. Serum Ang-2 and Tie-2 levels were correlated with the disease activity, as well as the type, localization and treatment of the disease. RESULTS: Median serum Ang-2 and Tie-2 levels were significantly higher in both the UC patients and the CD patients compared with the healthy controls (P < 0.05 and P < 0.001, respectively). The IBD patients with early disease (diagnosis < 2 years) had significantly higher (P = 0.04) median serum Ang-2 levels but significantly lower (P = 0.02) median serum Tie-2 levels as compared with IBD patients with late disease (diagnosis > 2 years). The CD patients with active disease had significantly higher levels of Ang-2 compared with non-active disease (P = 0.02). Serum levels of both Ang-2 and Tie-2 were not correlated with laboratory markers such as ESR, CRP, white blood cell count, platelet count and albumin. CONCLUSIONS: Serum Ang-2 and Tie-2 levels are elevated in patients with IBD. These markers may mediate angiogenesis and vascular permeability in the mucosa of patients with IBD.     

Macrophage migration inhibitory factor in the sera and at the colonic mucosa in patients with ulcerative colitis: clinical implications and pathogenic significance

BACKGROUND: Inflammatory cytokines produced by activated macrophages are implicated in the pathogenesis of ulcerative colitis (UC). With the theory that macrophage migration inhibitory factor (MIF) may have a role in the accumulation of macrophages, we studied MIF in UC. MATERIALS AND METHODS: A total of 27 patients with UC, 14 patients with Crohn's diseases (CD), 11 patients with other forms of colitis and 26 normal controls were enrolled in the study. The levels of MIF in the sera and culture supernatant were measured by an enzyme-linked immunosorbent assay. MIF, macrophages and T cells were localized at the colonic mucosa by immunohistochemistry. RESULTS: The levels of MIF in the sera were significantly higher in UC than in normal controls (P < 0.05), in serum C-reactive protein (CRP) -positive cases with UC than in CRP-negative cases with UC (P < 0.05), and in patients with severe colitis with UC than in mild colitis with UC (P < 0.05). There was a positive relationship between serum MIF levels with the CRP levels and activities of colitis. However, the levels of MIF in patients with CD and other forms of colitis were not significantly different from their levels in normal controls and UC. Infiltrating cells at the colonic mucosa in UC and CD expressed MIF. CONCLUSIONS: These data suggest a role of MIF in the pathogenesis of UC. MIF may be used as a marker of disease activity in UC and control of MIF production may have therapeutic implications.